NEW RESOURCE: YOHO’S APOCALYPSE ALMANAC tells how to treat many diseases. It is a little tongue-in-cheek, but it has references and links.
When my friend Stephen accompanied his father to the cardiologist, he politely told the doctor he knew that angioplasties only improve lifespan if they are done during an “ST elevation” heart attack. This is a desperate situation with obvious EKG changes, tremendous pain, and a significant chance of dying. Angioplasties do nothing for your chances of living longer if they are not performed during such an event.
Some non-emergency patients experience improvement after stent placement, but studies have shown that these procedures do not prolong their longevity. The problem is that stents soon clot off. This may be because few patients are entirely compliant with blood-thinner medicines.
That cardiologist had already scheduled Stephen’s father for a “routine” angioplasty and stent insertion. As you will learn below, this is both useless and unethical in terms of achieving a longer life. When he discovered that Stephen was familiar with his game, he immediately began treating him as a colleague and deferred to his judgment.
I told my friend that if I were his Dad, I would start intravenous chelation therapy several days a week and see the cardiologist solely for medication management. They understand that better than anyone else and are talented at “tuning up” cardiac patients with congestive heart failure. I would also take a lot of oral magnesium, not the Costco magnesium oxide, which is poorly absorbed but can loosen the bowels. If I could find a natural doctor to give magnesium to me intravenously, I’d get over there ASAP without passing GO on the way.
I’d also carry around nitroglycerine and take at least one 500 mg uncoated aspirin daily and not the ineffective 81 mg “baby” aspirin. I sent Stephen links to my magnesium article HERE and my related one on atrial fibrillation HERE.
If it were me, I would take DMSO, a teaspoon to a tablespoon, twice a day instead of the prescription blood thinner. I offer no guarantees about that idea.
Our healthcare situation has gotten so pathological that these simple and effective strategies are virtually never implemented today. Standard aspirin, the bestselling drug for decades, is seldom even found in drugstores and must be ordered online. At one time, heart attack patients were instructed to chew one up immediately if they had chest pain. These days, its excellent healing effects are concealed, and toxic Tylenol is promoted instead.
Not long ago, magnesium was given IV when heart attack patients reached the emergency room, and it saved lives. This is also a thing of the past, even though over half of us are deficient. Nitroglycerine prescriptions also seem to have largely gone the way of the dodo bird. It is long off-patent, making it unprofitable for the Pharma.
The following is an excerpt from my study of modern high-tech heart care, as told in “Butchered by Healthcare.” What doctors are doing now does not align with the science, and they are aware of this.
Cardiology and Cardiac Surgery
How much can a patient be expected to do, anyway? Caveat emptor may be an appropriate slogan for selling used cars or life insurance, but it is not a worthy dictum for health care. In the final analysis, it is not a patient's responsibility to protect himself against the medical profession; it is the profession's responsibility to protect the patient. —Jerome Kassirer, MD, On the Take (2005)
Coronary artery disease (CAD) is a blockage of the arteries supplying the heart with blood. It is the top cause of death in the US. When it happens suddenly, people get heart attacks, which damage the heart muscle, and they may die. We have high-tech weapons to treat this problem, but over the past few decades, studies have proven that they are nearly complete failures.
Coronary artery bypass grafting (CABG) heart surgery involves sewing new blood vessels into the heart arteries to permit blood to flow around blocked areas. This logically appealing, plumbing-type solution was first performed in the 1960s. The second approach, angioplasty, is a more recent development. Wires and tiny balloons are used to pry the arteries open, and mesh tubes called stents hold them open. This should only be done while a heart attack is occurring.
The first step in the modern approach is to identify people who have the disease and might get a heart attack. We ask patients about chest pain and “cardiac risk factors.” These include smoking, diabetes, cholesterol, high blood pressure, and family history. Being overweight and male are also risks.
If doctors are suspicious that the coronary arteries are partially blocked, they often have the patient do a “stress test.” This is a walk on a treadmill while the doctor checks the heart’s function using an EKG. Sometimes, imaging is used to look at the anatomy during this exercise. If heart disease seems likely, the patient then gets referred for “angiography” to see if there is a blockage. For this, the cardiologist squirts dye directly into the coronary arteries and takes x-rays.
Patients with chest pain have stress tests if their story and examination suggest heart problems. Those with suspicious stress tests and those who seem sick get an angiogram. After this, the doctors may consider surgery or angioplasty, depending on the situation. If the first treatment fails, the doctor will usually refer the patient to another specialist for the alternative treatment.
We perform stress testing nearly universally, but its predictive power is little better than a coin toss. Doing them does not improve survival. Radiologic imaging during stress testing is of little benefit, either. These tests are wrong twice as often as they are right. They often detect a 50 percent blockage, a routine finding that is a poor predictor of future death. This needs no invasive treatment.
CABG surgery is proven to lengthen life only for the tiny fraction of patients who have severe left main coronary artery blockage. This one-centimeter vessel feeds two of the three primary heart arteries. It divides into a Y, supplying its inflow, and then the blood goes through these into most of the heart. Significant obstruction in this tiny spot is found in only three (3) percent of all heart attacks.
After a CABG plumbing job around this small section, eighty-five percent of patients will be alive five years later, but only 65 percent of them will survive five years if they take medications. The twenty percent (20%) improvement in survival at five years for this small group represents the entire benefit for all CABG surgeries. Sewing artery bypasses around other areas of artery obstructions does not improve lifespan.
The whole multibillion-dollar coronary artery bypass surgery skyscraper was built on this slender foundation. No studies have ever shown other justifications. As early as 1989, a Veterans Administration trial found that cardiac bypass surgery did not improve overall five-year survival more than merely taking medications. Fewer people died of heart disease when they got the operations, but they did not live longer on average because they died of other things—including presumably the operation itself.
The heart surgery machine has enormous, teetering wings with no foundation at all. These include the claim that performing a complicated surgery to bypass blockages in all three coronary arteries works as effectively as bypassing the left main artery alone. Although operating on this “left main equivalent” situation seems reasonable, studies have proven that triple vessel surgery does not extend life (Worried Sick by Nortin Hadler, 2012).
The gorillas in the CABG room are the complications. Two to nine percent of the people getting the surgery die immediately, and about a third—some studies say half—of those surviving have significant, measurable brain damage. Angioplasty, in contrast, has few such issues, and the fatalities are only a fraction of a percent when performed for patients who are not having a heart attack. The cardiologists tout it as the safe way to treat CAD (David Newman’s 2014 review of CABG in theNNT.com is a balanced commentary from when the literature was already mature. He cites two dozen key references.)
The studies that debunked angioplasty and stents were as unforeseen and staggering as the ones that deflated CABG surgery. In 2007, the NEJM published the “COURAGE” trial of over 2000 patients (study authors like acronyms; this one somehow stands for “Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation”). It showed that neither stents nor angioplasty improved survival or subsequent heart attack rates in patients with stable coronary artery disease.
A follow-up report by these COURAGE authors showed improvements in angina and a few quality-of-life measures, but these effects lasted less than 36 months. Based on this slender support, the operations continued. The cardiologists thought it was reasonable because stent deaths are so rare.
Finally, the ORBITA study showed conclusively that these procedures were without survival benefit for stable cardiac disease in people who were not having a heart attack. Neither pain nor chances of further heart attacks decreased. This trial used an invasive “sham” or faked procedure for the control group, which is the most definitive type of surgical evaluation. There were only 230 patients, but the results were indisputable. (TheNNT.com has an excellent summary.)
Drug “eluting” stents leak drugs into the surrounding area, but they do not help patient survival either and cause an increase in blood clots. The science was clear: stents and angioplasty in routine care do not improve outcomes.
In 2019, a federally funded trial again discredited over 90 percent, possibly over 95 percent, of the cardiology and cardiac surgical invasive procedures. The researchers treated 5000 patients with stable heart disease with either CABG or stents. Neither therapy improved lifespan or heart attacks when compared to diet and drugs. These patients were not having heart attacks at the time of the interventions. The researchers also excluded those with left main coronary artery disease.
As for CABG surgery, there is one narrow case where stents supposedly work. This is during a severe heart attack when the EKG has a pattern called “ST-elevation myocardial infarction” or STEMI. This is a complete or near-complete coronary artery blockage. When stents are placed during STEMIs, the cardiologists proclaim they save one person in 40, a number needed to treat of 40.
The American Heart Association and many others worldwide promote this as “intervening during the golden hour” (recently, they have been yapping about this approach for strokes). Patients in their most vulnerable state, often in severe pain, get rushed from the emergency department to the catheterization lab and treated with angioplasty and stents. They are incapable of making reasoned decisions. Nortin Hadler summarizes: “Stenting belongs to one of the bleakest chapters in the history of Western medicine… Cardiologists are marching on because the interventional cardiology industry has a cash flow comparable to the GDP of many countries” (Hadler, ibid).
The latest marketing ploy is to remind the public about “atypical” pain, which is serious but unlike the usual, distinctive heart attack pain patterns. People are now racing to the hospital, into this dysfunctional system, if they have any twinge in their chest.
Angioplasty causes strokes, heart attacks, rhythm disturbances, and bleeding. Does angioplasty save more STEMI heart attack patients during a heart attack than are killed by the procedure? When performed during a heart attack:
ANGIOPLASTY SAVES: 1/40, or 2.5%
ANGIOPLASTY FATALITIES: 1/167 to 1/43: .6% to 2.3%
ANGIOPLASTY COMPLICATIONS: 1/50, or 2%
Does the 1/40 “saved” figure already take into account the people who die from the procedure? Considering the entire picture, I do not think it makes a difference, but if you still have doubts, consult your cardiologist. I doubt they could convince me.
If we could overlook the cardiologists’ conflict of interest and accept their numbers, the expense of performing angioplasties on 40 people to save one is 40 times the $35,000 cost, or $1.4 million. This is on the outer fringes of acceptability; one to two million dollars spent for each life saved has somehow entered the literature as reasonable. Since heart attack patients have an average age in their late 60s, the number of years of life being bought is uncertain. And there are many other ways to spend this money that would do more good and save more years of life.
In the US, at least 85 percent (the lowest figure I could find) of coronary angioplasties are performed on patients who have uncomplicated, stable chest pain, where there is no chance of success. And STEMIs are likely only a percent or two of all heart attacks.
To justify the process, cardiologists often send their patients to the emergency room, saying that they have “unstable angina.” This means that chest pain occurs without physical exertion, is not relieved by rest or medication, and may worsen. This diagnosis is often abused because it involves a subjective judgment with an imprecise definition. I spoke with emergency physicians in 2019, who confirmed that they frequently saw this scenario.
Note: when angioplasty is done like this as an “elective procedure,” for no patient benefit, and not during a heart attack, it thankfully only kills .2 percent or 1/500.
Conclusions
How can treating cardiologists and surgeons condone all this? Surgeons rarely look at statistical evidence. They say they see the heart come alive when the blood returns after they sew on new arteries. They support CABG surgeries based on the authority of their specialty.
Cardiologists continued to place stents despite studies proving they were ineffective. They say they have cases every week with an immediate decrease in chest pain after stent placement. However, they admit that stents soon clot off, especially when patients miss some of their anti-clotting drugs—a universal occurrence. Yoho 2025 note: If I were in this situation, I would instead take a tablespoon of DMSO in a glass of water daily and never miss it. My attempts to interview several of them about the statistics were met with hostility.
The University of California San Francisco cardiologist Rita Redberg said, “It’s just like a sugar pill. We know sugar pills make a lot of people feel better — though sugar procedures make even more people feel even better.” Dr. Katz agrees: Placebos work avidly for pain, especially placebo surgery.
Doctors are only human. Upton Sinclair explains: “It is difficult to get a man to understand something when his salary depends on his not understanding it.” Doctors do care for their patients, but because they are being paid, they struggle to reconcile issues like this.
How many of these procedures are performed? Although CABG surgery has been declining somewhat for nearly 20 years, about half a million are still done annually in the US. At approximately the same time each year, a million angioplasties are performed, and around a million patients have had stents placed (2013, 2018).
In the US, angioplasty and stents cost $20,000 to $50,000, while CABG surgery costs $70,000 to $200,000. If not covered by insurance, CABG costs about $28,000 in the UK. The US yearly bill for all stents is roughly $12 billion, and for CABG surgeries, the total is about the same. US cardiovascular disease, including stroke, costs nearly a billion dollars a day if lost productivity is included (CDC).
A proper diet and exercise are vital for a healthy heart, but what constitutes the optimal regimen is unknown. Exercise helps, but the studies are unclear.
Jason Fung credibly touts higher-fat diets and fasting (The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally by Jason Fung, 2018). He says that when people fast, their metabolism or internal caloric consumption stays high, which aids weight loss. By comparison, ordinary calorie-restricted diets lower metabolic levels, which is a big disadvantage. This sort of dieting may have permanent or near-permanent effects. Fung says his patients lower their cholesterol, eliminate diabetes, and discontinue most drugs.
Scientific proof is imperfect for any diet. John Ioannidis, a renowned expert on study design at Stanford, states that most trials of diet and health are flawed. They are too small, not randomized, or otherwise biased. Both diets above restrict calories, which may be responsible for the observed benefits.
The US has showered money and prestige on our heart doctors, who, in return, oversee our third most expensive and ineffective medical specialty after mental health and oncology. (This does not include dentists and pediatricians—they are the two worst and are in classes of their own.) Our national obsession with these high technologies has distracted us from the possibility of more straightforward solutions. Other first-world countries perform heart procedures at a fraction of our rate. They get less doctoring, which could be why their citizens live longer.
Synthesis
Before his latest brush with the cardiologist, Stephen ignored my ideas about what I would do if I were his Dad. This time, even though the doctor admitted I was right, Stephen went ahead with the angioplasty and stent and then took my other suggestions. Dad, who is 86, felt improved but never got worked up about it.
Honey always gets better results than vinegar. I write aggressively to teach, but if you act like me, doctors will ignore you, so always be respectful and deferential. Most do their best despite heavy pressures from outside, and you want them committed to helping.
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